Veterinary Surgery最新文献

Objective: To evaluate if high-volume lavage results in a negative bacterial culture of egress fluid, regardless of pathogen in an experimental model of equine septic arthritis.

Study design: Experimental study.

Animals: A total of 11 horses in three groups (lipopolysaccharide [LPS] Group 1, n = 4; Escherichia coli [E. coli] Group 2, n = 4; Staphylococcus aureus [S. aureus] Group 3, n = 3).

Methods: A middle carpal joint of each horse was injected with LPS (synovitis Group 1), E. coli (septic arthritis Group 2) or S. aureus (septic arthritis Group 3). Arthroscopic lavage of the middle carpal joint was performed 24-h post-injection. Egress fluid samples were collected every liter for bacterial culture. Liter samples 1, 5, 10, 15, and 20 were submitted for bacterial culture. Subsequent samples were submitted based on the results of the initial dataset.

Results: Predicted probability of a positive culture after 1, 5, 10, 15, and 20 L for E. coli and S. aureus, respectively were: 44.7% (p = .04) and 98.3% (p ≤ .001) after 1 L, 42.6% (p = .02) and 94.3% (p ≤ .001) after 5 L, 40.1% (p = .02) and 77.8% (p = .001) after 10 L, 37.6% (p = .04) and 42.5% (p = .08) after 15 L, and 35.2% (p = .09) and 13.5% (p = .32) after 20 L. LPS cultures (n = 4) were negative at every timepoint. Post-lavage 50% (2/4) of E coli. and 100% (3/3) S. aureus horses had positive synovial fluid cultures.

Conclusion: A total of 20 L of lavage fluid was not sufficient to result in a sustained negative bacterial culture.

Clinical significance: High-volume arthroscopic lavage alone is not sufficient as a treatment for septic arthritis.

Surgical limb-sparing in veterinary medicine can be defined as an intervention aimed at preserving limb function when a bone abnormality is present, namely neoplasia or a non-repairable fracture, and the affected segment of that bone needs to be removed and, most often, replaced. In some cases, the affected segment of bone is treated and reimplanted. It is mostly prevalent in the context of local tumor control while preserving limb function in veterinary surgical oncology but has also been employed for comminuted fracture repair. Importantly, this review focuses on neoplasia and non-repairable fractures wherein the bones were normal prior to the pathology and the non-affected segments of bone remain normal in the face of the pathology. Several techniques have been reported and vary based on a number of factors such as anatomic location of the pathology and method of addressing the defect created by removal of the affected bone segment. Limb-sparing techniques have been documented to have comparable survival times to limb amputation but can be fraught with mechanical and biological complications, requiring intensive long-term care and client compliance with treatment regimens. The most common complications are infection, mechanical failure, and local recurrence. Decreasing the risk of complication is the driving force for research in the field of limb sparing in dogs. The aim of this review was to compile the existing literature on surgical limb-sparing in dogs with the intent to guide clinical decision-making and inform further research on limb-sparing.

Objective: To compare the feasibility and biomechanical stability of two surgical techniques for fixation of vertical plane fractures of the accessory carpal bone (ACB).

Study design: Randomized experimental ex vivo study.

Sample population: Eight equine accessory carpal bones were included in a control group. A total of 20 equine cadaveric forelimbs were randomly assigned into two groups (n = 10 per group).

Methods: Vertical plane fractures were created palmar to the extensor sulcus using an oscillating saw. In Group 1 (CS), fractures were stabilized with two 4.5 mm cortical screws in lag fashion. In Group 2 (XP), fixation included one 4.5 mm cortical screw in lag fashion and a laterally applied angular stable X-plate with four 2.7 mm locking screws. Control ACBs were excised and tested under axial compression using a four-column testing machine. Postoperative specimens in Groups CS and XP were tested under the same conditions. The failure mode was assessed radiographically.

Results: The mean maximum strength of native bone was 11.26 (±2.14) kN. Two constructs per group were excluded due to cortical screw protrusion. No difference in failure load was observed (CS: 6.82 [±2.34] kN; XP: 8.02 [±1.10] kN; p = .7558). Failure mode analysis revealed a greater fracture gap size (p = .0039) and implant bending in CS specimens (p = 1.074e-7).

Conclusion: Both techniques were feasible, though neither restored native bone strength.

Clinical significance: A lateral X-plate with a single cortical screw demonstrated equivalent biomechanical performance to two cortical screws and was technically less demanding, offering a simpler fixation option for ACB fractures.

Objective: To evaluate the rate of residual polystomatic sublingual acinar tissue if tunneling dorsal to the digastricus muscle and dissection to the sublingual caruncle is not performed during mandibular-sublingual sialadenectomy in cats.

Study design: Cadaveric study.

Sample population: A total of 10 feline cadavers.

Methods: Mandibular-sublingual sialadenectomy was performed bilaterally in 10 feline cadavers using a ventral or ventrolateral approach in a randomized fashion. Salivary ducts were dissected as far rostral as possible with retraction of the masseter and digastricus muscles until they traveled dorsal to the digastricus muscle, where a ligature was applied. The position of the lingual nerve was identified. Following tunneling, dissection continued rostrally to the sublingual oral mucosa, where ducts were excised. Histology of dissected tissue rostral to the ligature was performed.

Results: Histology identified evidence of salivary acinar tissue in 13/19 (68.4%) specimens - 7/10 (70.0%) of specimens obtained with the ventral approach and 6/9 (66.7%) of those obtained with the ventrolateral approach (p > .99). In all cases, the lingual nerve was identified with retraction of the masseter and digastricus muscles without tunneling.

Conclusion: Tunneling dorsal to the digastricus muscle exposed additional polystomatic salivary acinar tissue in most cases.

Clinical significance: Tunneling dorsal to the digastricus via a ventral or ventrolateral approach may decrease the rate of polystomatic sublingual acinar tissue being left in situ in clinical cases.

Objective: To determine the prevalence of popliteal sesamoid displacement (PSD) in dogs with cranial cruciate ligament disease (CCLD) on radiographs, assess its reduction following tibial plateau leveling osteotomy (TPLO), and evaluate cranial tibial subluxation (CTS) pre- and postoperatively.

Study design: Retrospective radiographic observational study.

Sample population: A total of 163 client-owned dogs diagnosed with CCLD and treated with TPLO.

Methods: Pre- and postoperative 90° flexion radiographs were reviewed to assess CTS, tibial plateau angle (TPA), stifle opening angle, PSD, and osteotomy localization. Statistical analyses evaluated associations between PSD, CTS, TPA, and osteotomy location.

Results: A PSD was observed in 14.4% of cases preoperatively and was associated with significantly higher CTS. Popliteal sesamoid reduction was achieved in 100% of cases post-TPLO. The CTS persisted postoperatively in all dogs with preoperative subluxation (N = 82; 50.3%), though at significantly reduced levels. Osteotomy positioning did not significantly affect postoperative CTS. Postoperative TPA showed a weak negative correlation with residual CTS.

Conclusion: A PSD is an infrequent finding, typically associated with more pronounced preoperative CTS. This displacement reliably resolves after TPLO when CTS was minimal. Although postoperative CTS was frequently observed, it was generally mild and not significantly affected by the osteotomy location.

Clinical significance: The PSD occurs infrequently after CCLD but is associated with increased CTS. Popliteal sesamoid reduction was associated postoperatively with minimal CTS and appropriate TPA. Radiographic assessment of popliteal sesamoid reduction may provide an additional, objective parameter for detecting any residual cranio-caudal instability following TPLO.

Objective: To determine whether radiographic templating of femoral stem size for total hip arthroplasty (THA) using extended and flexed hip radiographs are interchangeable.

Study design: Retrospective radiographic study.

Sample population: A total of 25 dogs evaluated as THA candidates.

Methods: Hip-extended and hip-flexed radiographs were templated for femoral stem implant size by three surgeons. A fourth investigator measured femoral length, canal flare index (CFI), and osteoarthritis scores for each projection and recorded implant size from surgical records. Templated stem sizes from each projection were compared with the implanted stem sizes using Bland-Altman analysis. Descriptive statistics were reported based on data distribution.

Results: Templated femoral stem size differed between surgeons (p = .014); the median (IQR) stem size was #9 (8-10) for one surgeon, compared to #8 (7-9) for the other surgeons. Templated stem sizes on extended and flexed radiographs were #8 (7-9) and #9 (7-9), respectively (p < .0001). The mean (SD) CFI in extended and flexed projections were 1.61 (0.21) and 1.89 (0.30), respectively (p < .0001). Implant size was underestimated using the extended projection (mean difference: -0.54) and overestimated using the flexed projection (mean difference: 0.30). Positive proportional bias was present between the extended and flexed projections (slopes: 0.22 and 0.25; p < .003).

Conclusion: Neither templating method consistently predicted the clinical femoral stem implant size.

Clinical significance: Hip-flexed templating may serve as a practical alternative when extended projections are not possible, though intraoperative assessment remains essential for final implant selection, particularly since measurement bias increased for stems larger than size 9.

Objective: To determine the accuracy and safety of two established landmark-based techniques and two novel techniques for stifle arthrocentesis in dogs.

Study design: Ex vivo prospective study.

Animals: A total of 32 paired canine cadaver pelvic limbs.

Methods: An electronic survey assessed technique prevalence among surgeons. Pelvic limbs (n = 32) were randomized to one of four techniques; lateral intercondylar notch (LINC), infrapatellar (INFRA), suprapatellar (SUPRA), or proximal lateral parapatellar pouch (POUCH) technique, with n = 8 per group. Repositions, attempts, and synovial fluid presence were recorded. Stifle arthrography assessed accuracy. India ink assay assessed iatrogenic articular cartilage injury (IACI). Omnibus tests were used (p < .05), with post hoc Bonferroni-correction (p < .0083).

Results: A total of 40 surgeons responded, with LINC most commonly used (35/40, 87.5%). All tested techniques were accurate (8/8, 100%, p > .9). INFRA and SUPRA required more needle repositions (median 3 and 2, respectively) than LINC and POUCH (median 1 for both), (p = .001). LINC and SUPRA produced no IACI, INFRA (6/8, 75%) and POUCH (3/8, 37.5%) (p = .007). Over half of IACI produced with INFRA exceeded 10 mm² in area, all on weightbearing cartilage (p = .041). POUCH injuries occurred exclusively on non-weightbearing cartilage (p = .041).

Conclusion: LINC and INFRA are currently used clinically and were accurate; however, INFRA required increased repositions and had high IACI rates on weightbearing cartilage. Two novel techniques were feasible and accurate; SUPRA was safe with no IACI, while POUCH had high IACI risk on non-weightbearing cartilage.

Clinical significance: SUPRA may be a safer alternative than current established techniques and warrants further clinical investigation. INFRA carries high IACI rates.

Objective: To report the outcomes of titanium mesh (TM) cranioplasty without polymethylmethacrylate (PMMA), incorporating a deliberate gap between the foramen magnum decompression (FMD) surface and the TM, in small-breed dogs with Chiari-like malformation and syringomyelia (CM/SM).

Study design: Retrospective clinical study.

Animals: A total of 87 client-owned small-breed dogs diagnosed with CM/SM by magnetic resonance imaging, all presenting with neurologic deficits.

Methods: All dogs underwent modified FMD. A gap was preserved between the FMD surface and the TM to facilitate tissue integration and reduce postoperative compressive forces. Clinical status was assessed based on neurologic improvement, medication dependency, and need for revision surgery.

Results: Surgical decompression with the modified TM technique resulted in sustained clinical improvement in most dogs. A total of 76 dogs (87%, 76/87) showed long-term improvement, and no revision surgeries were required during a median follow-up of 35 months (range: 27-73 months). Follow-up evaluation comprised postoperative computed tomography (CT) imaging at 6 months, as well as structured telephone interviews with owners to monitor clinical status. Only a small subset of dogs (13%, 11/87) required continued medication after surgery due to recurrence of signs.

Conclusion: Retrospective analysis showed that the modified TM technique, using a deliberate gap, was safe and effective in small-breed dogs with CM/SM, successfully preserving the decompression space and maintaining long-term neurologic stability.

Clinical relevance: The modified TM technique approach achieves durable neurologic improvement and minimizes long-term complications in small-breed dogs, demonstrating practical utility in managing this clinically challenging population.

Objective: To compare implant failure and gap displacement characteristics of simulated medial mid-body proximal sesamoid bone (PSB) fractures repaired with bone-screw-fasteners (BSF) or cortical screws (CS) in single or double screw configurations.

Study design: Ex vivo experimental study.

Sample population: A total of 14 paired equine cadaver forelimbs.

Methods: Medial mid-body PSB osteotomies were created in each forelimb. Surgical repair was performed using either: (1) single 3.5 mm BSF (BSF_single), (2) single 4.5 mm CS (CS_single), (3) two 3.5 mm BSFs (BSF_double), or (4) two 3.5 mm cortical screws (CS_double) (n = 7 repairs/group). Biomechanical properties and failure characteristics were evaluated through a single cycle to failure. Comparisons between groups were made using Wilcoxon-matched pairs or Mann-Whitney tests. Statistical significance was p < .05.

Results: The BSF_double group (2081 ± 181 N) had significantly higher yield than BSF_single (1458 ± 92 N, p = .01) and CS_single (1532 ± 86 N, p = .02) groups. The CS_double group (2101 ± 126 N) had significantly higher yield than BSF_single (p = .001) and CS_single (p = .003) groups. Biomechanical properties were not different between BSF_single and CS_single groups, or between BSF_double and CS_double groups. Gap measurements at construct failure were significantly higher abaxially than axially in all groups (all p < .05).

Conclusion: No differences were detected between the single BSF and 4.5 mm CS for repair of medial mid-body PSB fractures. Surgical repair using two screws has biomechanical advantage to single screw repair, regardless of screw type ex vivo.

Clinical significance: The BSF is not different to CS for repair of PSB fractures. Counteracting abaxial forces in surgical repair of mid-body PSB fractures warrants further investigation.